Pattern and clinical presentation of constipation in children in Sudan

Constipation represents a common problem in children. The worldwide prevalence of functional constipation in children varies from 0.7% to 29.6%. The aim of this study is to identify common causes of childhood constipation, clinical profiles of functional constipation. All children less than 16years old who suffered from constipation and attended Gaafar Ibnaouf specialized children hospital and gastroenterology private clinic of one pediatric gastroenterologist between June 2011 and May 2012 were included in this study. Patients were considered having functional constipation if there were no objective evidences of pathological condition, and the rest were termed as organic constipation. A total of 150 children suffered from constipation were seen. [81males], the age was divided into three groups, the majority 96 [64%] aged between 1-5years, and the least were 12 [8%] aged less than 1year.133 children [88.7%] had functional constipation, while the remaining 17 children [11.3%] had an associated organic disorders, among them 12 children [8%] had Hirschsprung's disease, 2children [1.3%] had hypothyroidism, 2 children [1.3%] had celiac disease, and 1child [0.7%] had cerebral palsy. The main clinical characteristic of functional constipation were faecal impaction presented in 59.4% of patients, straining in 43%, withholding behavior in 32.3%, soiling in 16.5%, abdominal pain in12% of patients. Functional constipation is the most common cause of constipation in Sudanese children

Neurological manifestaions among Sudanese patients with multiple myeloma

Multiple myeloma may involve the nervous system at every level, including the neuromuscular junction, peripheral nerve, plexus, spinal nerve root, spinal cord, meninges, and brain. Such involvement may be primary or secondary, as well as non-invasive paraneoplastic effects. To find out the perevalence and pattern of CNS manifestations in Sudanese patients with multiple myeloma seen in Al-Shaab Teaching Hospital and Khartoum Nuclear Hospital. Methodology: This is a prospective descriptive cross sectional, hospital based study. It was conducted in Al-Shaab Teaching Hospital and Khartoum Nuclear Hospital in the period from June2009 to June 2010. 50 patients with multiple myeloma were included in the study. Males were more than females with ratio of 2.8:1. The common [36%] age of presentation was between 55-64 years. There was increased incidence of multiple myeloma in patients from the west of Sudan. Farmers and free workers had high incidence of multiple myeloma [34% and 27% respectively]. The study demonstrated that the most common non-neurological symptoms was locomotor symptoms [24%], while the most common neurological symptoms were backache and neck pain. The most common neurological findings were cord compression [8%] followed by peripheral neuropathy [2%] and CVA [2%]. 22% of patients completed treatment with good response, 12% with partial response, 18% with no response and 48% are still on treatment. CNS involvement among our studied group was not uncommon

HBV, HCV and HIV among patients with Hemophilia in Khartoum- Sudan

Hepatitis B, C and HIV infections and their impact forms one of the major health problems worldwide and in Sudan. Studies of hepatitis B, C and HIV virus among hemophiliacs in Sudan are lacking. The main objective is to determine the screening, vaccination, seroconversion of hepatitis B, C and HIV among Sudanese hemophilic patients registered in Hemophilia Center Khartoum Teaching Hospital. During the period from July to November 2008, sixty two hemophilic male patients were randomly selected from hemophilic patients attending Hemophilic Center and were studied using simple direct standardized interview questionnaire and a blood sample from each patient was taken after consent for screening for hepatitis B, C and HIV. Out of the 62 patients, 39 [62.9%] were found to be screened before this study. Out of these 23[58.97%] were fully vaccinated for HB V, 23.08% were partially vaccinated and seven had no vaccination at all. Only one patient had seroconverted to HBsAg positive. HCV was detected in eight patient one of them was also found to have HIV infection. The low figures of HBs Ag positivity we got in this study is probably an under estimation of the actual prevalence of HBV as we did not use other serological marker and modern technology for detection of exposure to HBV. To determine the real magnitude of the problem we have to applying other markers like HBc Antibody in the screening procedures which are simple and cost effective. The coverage of our hemophilic patients with HBV vaccine was 52% so a significant number of our patients are at risk of contracting HBV. Unlike HIV, HCV was detected in an alarming percentage. Health education is a cornerstone in prevention of these serious viral infections

Recurrent exudative pleural effusion with flare up of chronic hepatitis B virus infection

We describe herein a young male patient who presented with exudative pleural effusion that appeared with flare up of chronic HBV infection and spontaneously recovered with the clinical and biochemical improvement of the hepatitis on two occasions five months apart. Other causes of hepatitis and exudative pleural effusion were excluded with appropriate investigations

Esophageal stricture causes and pattern of presentation at Ibn Sina Specialized Hospital

The aim of this study is to evaluate the causes and pattern of presentation of esophageal stricture in Ibn Sina Specialized Hospital. This is a retrospective study done at Ibn Sina Specialized Hospital during the period from April 2008 to December 2008. All patients had upper gastrointestinal endoscopy [UGIE], and those who were found to have esophageal stricture were enrolled in the study. The data collected were then processed and analyzed using appropriate statistical tests. Out of 780 patients who had UGIE, 60 were found to have esophageal stricture; 37 [61.6%] were males. The age group ranged between 20 years and 89 years, with a mean [ +/- SD] age of 50.483 [ +/- 17.437] years. Esophageal cancer of the squamous cell carcinoma type [SCC] was the most important cause of stricture in the study. In both genders, the cancer was common in the elder age groups. Dysphagia was the commonest presenting symptom. Malignant and benign strictures were located at different site of the esophagus. In males postsclerotherapy was more common especially in the young, while peptic stricture was common in elderly. In females peptic stricture and esophageal webs were common in young adults [20 - 50 years]. Endoscopic dilatation was performed successfully to 59 patients. Only one male in the age group 60 - 69 years was managed with percutaneous endoscopic gastrostomy [PEG] tube due to failure of dilatation. Esophageal stricture is an alarming sign of malignancy. Post-SCC stricture was detected in a considerable number of patients in our study group, therefore it require careful early diagnosis and distinction from other varieties because of their good outcome. Adenocarcinoma and other malignant tumors which cause esophageal stricture were not detected in our study group. Alcohol consumption was not a significant risk factor contributing to the development of post-SCC stricture in this study. Post-sclerotherapy stricture represented the peak in male farmers residing in the center of Sudan compared to females, other occupations and regions, and to other causes of benign stricture

pattern and presentation of myasthenia gravis in Al-Shaab and Omdurman Teaching Hospitals

Myasthenia gravis [MG] is the most common acquired autoimmune disorder of neuromuscular transmission. It has different patterns of presentation.to study the pattern and mode of presentation of Myasthenia Gravis in Al-Shaab and Omdurman Teaching Hospitals, Khartoum Sudan. The demographic and clinical characteristics of 50 patients of myasthenia gravis [MG] were reviewed in Alshab and Oumdrman Teaching Hospitals for five months period from May to October 2008. Out of 2400 patients attending neurology clinics 50 were found to have Myasthenia Gravis [MG] with female; male ratio of 2.5:1. The age at presentation was the second decade of life in 34%. Most of the patients [42%] were from Khartoum State followed by North Kordofan State [14%]. High occurrence of late onset fatigability and weakness was seen in 92% of our patients. Ocular muscles involvement was detected in 78%. MG was aggravated by hot weather and fever in 12% of the patients. Quinine represented the most common drug which aggravated the myasthenia symptoms in 4%. Diabetes mellitus and thyroid diseases were the most associated auto immune diseases seen in 12% and 4% respectively. The diagnosis was made by classic history and neurological examinations in 88% and positive neostigmin test in64%. The majority of patients were treated with steroids. Thymectomy was done in 10% patients. The outcome was excellent as 82% improved and only one [2%] patient died. Going with literature diagnosis of MG was made depending on classical history, full neurological examination and confirmed by tensilon test. Because of different reasons more sophisticated tests were not done in our patients. Only patients with malaria who were treated with quinine showed deterioration of their symptoms in our study. Strikingly, myasthenia crisis which were reported in 27% of patients were not seen in our population. Because of lack of usage of steroid sparing agents the vast majority [96%] of our patients were treated with steroids. Generalized myasthenia gravis with ocular involvement is common in our patients. However, pure OMG was not seen. Thymectomy was done in a small number of our patients with reference to other studies

Transient glutenopathy and abdominal tuberculosis; a cause or effect? preliminary report

Tuberculosis remains an important disease worldwide. It is difficult to estimate its incidence In children. The association between intestinal tuberculosis and glutenopathy was not reported before. Three hundred patients who presented with chronic diarrhea to Oaafar Ibn Auf Specialized Children Hospital, Khartoum Sudan were investigated for intestinal tuberculosis and gutenopathy. The children were divided into two groups both were put on treatment for tuberculosis. However, one group was put on gluten free diet as well. The serological markers and intestinal biopsies were taken initially, six months after commencement of treatment and six months later. Also their clinical response to treatment was encountered. Out of the 300 children who presented with chronic diarrhea, 30 were diagnosed to have intestinal tuberculosis. Their ages ranged between 2-10 years. At commencement of the study all the patients [30] had positive IgA and IgG antigliadin antibodies and anti tTG [table I]. The group which was put on gluten free diet showed rapid clinical, biochemical and histological response. Despite the limitation of this preliminary study; we can conclude that ITS can cause transient glutenopathy and gluten free diet may facilitate clinical recovery in patients with ITB